By Beverly Cosgrove, Revision 18, May 17, 2021
For AMAB trans people who take estrogens, the best combination of safety and effectiveness is to use self injection of estrogen, particularly in the form of estradiol valerate, and this is what I suggest patients request from their doctors. In the case of AFAB trans people taking testosterone in oil, the need for self injection is even more obvious. The biggest problem is that doctors and nurses usually advise their patients to use the WRONG syringes and needles for the purpose. So, here is a quick startup guide on the subject of:
First, just to be clear: Self medication is not for everyone, in particular those who have heart disease, history or risk of cancer, diabetes, and other conditions which can only be judged by a medical professional. However, we live in a world trying to prevent some of us from getting appropriate treatment, and some patients have felt forced to take pills secretly. It’s bad enough that a patient is self treating, but doing so with pills is usually the worst choice. Injection (self injection or otherwise) is in most cases the choice for best safety and effectiveness, whether you are “DIY” or have a legitimate medical provider. And you will want to save money, and may be surprised to find that ordering your own supplies online can save you a lot of money even if your insurance already covers your supplies. For AMAB trans people, the costs can be as low as about $19 a month in the US, using cash only, no insurance needed. Surprised? See this summary. Note that the information I give here also applies to AFAB trans people injecting testosterone.
There are THREE basic injection methods for transgender people (both AMAB and AFAB). Before reading on, you will need to decide which of the three is your choice. The equipment needed for each method is different from the others. The three methods are Long-needle Intramuscular (LIM), Two Needle Subcutaneous (2S), and One needle Subcutaneous (1S). The LIM method is generally most effective, doses being equal, but complicated since there are 3 parts, and seems awkward to those who have not done it before. (Do it 10 times and you will feel like an expert, though.) The “2S” method (2-needle subcutaneous) is usually least painful, and least distressing for those with needle phobias; I now use the 2S method myself. The “1S” method (1-needle subcutaneous) is simple but slow to do; it can also hurt more than the 2S method; my partner uses this method.
I am listing links to sources on this page. Feel free to leave a message if the link is broken, inaccurate, or there is a better link you think should be included — but don’t expect me to do an update every day. UPDATE 5-17-2021: Shortages due to the Pandemic have worsened, and many sources are sold out. I will update this post periodically.
LINKS FOR THE LONG NEEDLE INTRAMUSCULAR METHOD
First, the Long Needle IM method. In this method, you use a 1CC syringe, and attach a 22G needle to draw the hormone/oil medication into the syringe. Then you remove and discard the 22G needle, and attach the long needle, and do the injection into the upper outer quadrant of the Gluteus Maximus (buttocks). Because the injection site requires the needle to pass thru the smaller Gluteus Medius into the large Gluteus Maximus, the needle needs to be long enough to penetrate, at least 1.25 inches. A shorter length is not as effective, probably because it risks the needle expelling the dose into the boundary between the Maximus and Medius, where the dose is quickly picked up by the system and dissipates, failing to make a long lasting depot site. Because the needle is long and thin, the syringe MUST be a 1cc (1 ml) size, for hydraulic reasons. (For you science fans, force times throw is inversely proportional to the ratios of the cross sectional areas. Think of how automobile brakes work.) Do not attempt to use a 2.5 ml or a 3 ml syringe. Do not attempt to use a “Luer Slip” syringe – make sure it says “Luer Lock”.
LIM 1ml Syringe sources.
(Above: the BD 1ml syringe. BD does not have the full displacement plunger that some syringes feature, which pushes out the last drop of the hormone dose and reduces waste. In the list below I have indicated the syringes with a full displacement plunger with the initials “FDP”. Also note that BD syringes are in shortage and their price is about 4x normal, which is ironic because the other syringes are FINE. I have personally tested each of these except the Caretouch. I presently use the Global Easy Glide, which I ordered in quantity 1000 and got an extremely low cost for a 20 year supply.):
Nipro 1ml Syringe, box of 100, $7.87, LAC
BD Luer-Lock Disposable Syringe, 1 ml, 100/bx, $49.99, #309628, Ferris
BD Luer-Lock Disposable Syringe, 1 ml, 100/bx, $46.99, #309628, ShopMedVet (Out of Stock)
BD Luer-Lock Disposable Syringe, 1 ml, 100/bx, $44.99, #309628, Healthykin
Kendall Luer-Lock Disposable Syringe, 1 ml, 60/bx, $33.15
Caretouch 1ml Syringe Only with Luer Lock Tip, 100 for $25, Walmart
Easy Glide Luer-Lock Syringe, 1 ml, 100/bx, $17.35, Amazon
Easyglide Luer-Lock Syringe, 1 ml, 25/bx, $9.99, Amazon
Exel 1ml Luer Lock FDP Syringe, qty 100, $23, Air Tite
Global Easy Glide 1ml Luer Lock FDP Syringe, qty 25, $10.99, Ebay seller
Above is an example of an Ebay listing. These listings change rapidly, but as long as the syringe is 1ml, and is Luer Lock, then it is probably suitable. However, be warned that some sellers use Ebay as a place to dump ruined stock, which may have heat or water damage, so be sure to check Ebay feedback and return any product which shows packaging defects.
LIM draw needle, 22 Gauge 1 inch sources:
McKesson Hypodermic Needles-22 Gauge x 1″, Box of 100, SKU:16-N221, $3.95, Healthykin
Nipro Hypodermic Needle 22G, Ebay
LIM Injection needles. The needle should be 25 or 27 gauge, and at least 1.25 inches long. This gives 3 sizes: 25G/1.5, 27G/1.25, and 27G/1.5 (Nipro needles are recommended for best comfort, but Nipro does not make the 27G/1.5 size.)
Nipro Needle, 27G X 1-1/4, shopmedvet, box of 100, $4.95
AHS needle, 27G x 1.5, ShopMedVet, box of 100, $3.99
CareTouch needle, 27G x 1.5, SaveRiteMedical, 100 for $7.50.
BD needle, 27G x 1.5, MedOnTheGo, 100 for $23.55
Nipro Hypodermic Needle 25 Gauge, 1 1/2″, 100 Count
LINKS FOR THE TWO-NEEDLE SUBCUTANEOUS METHOD
Second, there is the Two-Needle Subcutaneous method. In this method, you use a 1CC syringe, and attach a 22G needle to draw the hormone/oil medication into the syringe. Then you remove and discard the 22G needle, and attach the 30g 1/2 inch long needle, and do the injection shallowly at an angle into the fatty layer of the abdomen. See my main article on this subject. Because the needle is very thin, the pain level is very low, but as with the LIM method the syringe MUST be a 1cc (1 ml) size, for hydraulic reasons. (For you science fans again, force times throw is inversely proportional to the ratios of the cross sectional areas. Think of how automobile brakes work.) Do not attempt to use a 2.5 ml or a 3 ml syringe. Do not attempt to use a “Luer Slip” syringe – make sure it says “Luer Lock”.
2S 1ml Syringe Sources
Use the same syringe as in the LIM method, above. See the list here.
2S draw needle, 22 Gauge 1 inch sources:
Use the same draw needle as in the LIM method. See the list here.
2S injection needle, 30 Gauge 1/2 inch (12mm) sources (Nipro recommended):
Nipro Needle, 30G X 1/2″, Hypodermic, 100/BX, AH+3013, ShopMedVet, $6.95 per box
Nipro Needle, 30G X 1/2″, Hypodermic, 100/BX, AH+3013, HealthWarehouse, $10.95 per box (Out of Stock)
You probably noted that I recommend the Nipro needle — especially over the BD needle. This is because the Nipro needle is so sharp that it significantly reduces injection pain. I can attest to this, after using many different brands of needles, many years, hundreds of times, I am convinced that the Nipro really are superior. Nipro says: “The FLOMAX needle wall is ultra-thin compared to a conventional needle, permitting rapid and efficient drug delivery. A proprietary grinding process results in an exceptionally sharp lancet point able to penetrate tissue smoothly and with minimal trauma.” Furthermore, Nipro needles are among the lowest cost ones available. You will not be offered Nipro needles in any US pharmacy — you must buy them online.
LINKS FOR THE ONE-NEEDLE SUBCUTANEOUS METHOD
Finally, we come to the 1-needle subcutaneous method. This uses one of several “Insulin syringes” which may come in three volumes: 1 ml, 0.5 ml, or 0.3 ml, but all of them have a fixed needle which acts as both as your draw needle and your injection needle. These combos have some disadvantages: (1) the needles tend to be thicker wall ones with a higher pain factor, (2) since you must draw with the same needle as you inject with, the needle becomes dulled and thus more painful from being forced thru the rubber seal, and (3) the thin needle can be VERY slow to draw up the oil. Despite these drawbacks, the combo needle is popular because it is so simple and compact. In choosing the combo for you, buy only the smallest volume that fits your injection amount. The 0.3 ml size is much easier to inject with than the larger sizes, so if you can set your injection volume to less than 0.3 ml, that should be your choice.
3/10 ml size:
BD Ultra-Fine Insulin Syringes 30G 3/10 cc 1/2 inch 90/bx, $21.34, ADW Diabetes
Exel Syringe & Needle, .3mL, 29G X 1/2in., 100/BX, ShopMedVet, $14.48
5/10 ml size:
BD Ultra-Fine Insulin Syringes 30G 5/10 cc 1/2 inch 90/bx, $21.34, ADW Diabetes
Exel Syringe & Needle, .5mL, 29G X 1/2in., 100/BX, ShopMedVet, $12.28
1 ml size:
BD Ultra-Fine Insulin Syringes 30G, 1 cc 1/2 inch 90/bx, $21.34, ADW Diabetes
Exel Syringe & Needle, 1mL, 29G X 1/2in., 100/BX, ShopMedVet, $12.28
SOME COMMON QUESTIONS
“I inject into my thigh. Can I use a 1 inch needle?” First, I recommend you do NOT inject into the thigh. Thigh injection causes surges of hormones in the system, and may not reliably form a slow release depot, which is the object of the IM injection. Thigh injection is fine for many things such as vaccinations, antibiotics, etc but NOT for hormones in oil. The results may tend to be weaker and last fewer days, requiring injections every 3, 4 or 5 days. Many doctors and nurses are unaware of this, but ask a hormone specialist if you want an expert opinion. Finally, the needle: I can’t really say if a 1 inch needle will degrade the results of a thigh injection, which is already giving poor results anyway. It certainly can’t help. Long needle injection into the gluteus is the high performance method.
“I’m small and thin, so can I use a 1 inch needle for gluteus injection?” If you are a normal adult, the 1.5 inch needle is really the needle considered the “gold standard”. The 1.25 inch 27G Nipro needle is fine also. The 1 inch needle is getting too short. If you are a child, that’s different. But if so, I think you should have your parent give you your injection.
“My nurse says that she discourages patients from gluteal self injection because they might hit their Sciatic nerve, and hurt themselves.” The nursing profession has lately taken this stance, possibly due to student nurses using bad technique, perhaps on children. The chances you will hit the nerve is zero if you use the right location and follow instructions — that nerve should be at least 4 inches away, at the closest, from the injection site, and MUCH deeper than 1.5 inches. Talk to your doctor and nurse about this. I have coached and worked with many thousands of trans people for over 30 years and never once has anyone hit the nerve. But if you run into implacable resistance from your medical providers — switch to subcutaneous injection.
“Isn’t it ok to inject into the Deltoid (arm)?” No. For oil-based hormones, this is as bad as thigh injection, maybe worse — and my answer above for thigh injection applies. While you may get some depot action, it will likely be very poor efficiency. Deltoid injections of oil-based hormones are a way to waste a lot of hormones. Use gluteal injection instead, and you may get the same effectiveness with a third the dose. Subcutaneous injection is also usually more efficient than deltoid or thigh, so consider that instead.
“Needles scare me.” Honestly, I understand. But injection has significant health advantages over pills, and it is really worth it. You’re going to have to get over your phobia, and perhaps this is the time to tackle it. Remember, you are going to need to get blood tests while taking hormones too. Not to mention electrolysis of facial hair, for some. Try to determine if it is the size of the needle that scares you. If it is, then subcutaneous injection with the tiny 30G 1/2 inch needle is the way to go — nearly painless and almost always bloodless. Take it one step at a time.
“Luer-slip syringes are easy to buy and are cheap! Can I use them?” Stay away from the Luer-slip style. These syringes are meant to be pressed into the needle, and are a “lance fit”. However you cannot change the needle without contamination from the oil. This can cause them to “pop off” just when you are doing your injection, leaving a mess of spilled hormones all over you. Luer-Lock syringes exist for a very good reason!
“I draw my hormones from glass ampules, not rubber-sealed vials. Should I use a different draw needle?” Good question. Yes, instead of the 1 inch needles I listed, you probably should get a 1.5 inch needle, so that you can reach the bottom of the ampule easier. There are also some needles which have a built-in filter, meant to make it impossible for tiny glass fragments to be drawn into the syringe. I personally don’t think they are important but I’ll leave this up to you. Filter needles are more expensive. If you use good technique in opening your ampules, the chances of glass particles should be minimal.
“One of the sites you listed will not ship to my state for legal reasons. What can I do?” The easiest thing to do is to buy from Ebay or Amazon, where these restrictions generally are not a problem.
There are many myths about injections. See my article here, where I try to debunk a few of them.
Feel free to leave comments, with your favorite links, and I’ll try to include them.
16 thoughts on “Selecting and Obtaining Supplies for Self-Injection of Oil-Based Hormones”
I disagree with you
You do NOT have to use at least a 1.25” needle I use a 1” and it works fantastically
The length would depend on how big you are
Also a 3ml is fine does NOT have to be a 1ml
I have NO problem infecting
Laur lock YES I do agree there it makes sure no leak and won’t come off
I agree no thigh besides it’s NOT recommended anyway
And draw with a 18g needle not a 22g it’s so much easier and a 23g needle to inject
I have a needle phobia and a23g no pain
I understand your “report” is ONLY YOUR OPINION and is not to be considered as GOLD STANDARD
Everyone’s body is different and MANY can use a shorter needle and YES if you inject in the proper location you are far enough away from the sciatic nerve
Piper, I’m glad you feel your shorter needle “works fantastically” for you. There’s always a chance that a short needle will work for an individual to a certain extent. But for reliability and highest efficiency the long needle is essential. Thigh injection “works” too, in that sense – works badly, but works. It is hard to say how much better the long needle will work for you, but it will, for efficiency or reliability or both. However, using a 18G needle as a draw needle is definitely a bad idea – the large cutting edge will damage the rubber seal so that after a few uses you will have lost your airtight seal, and probably have tiny bits of cut rubber floating around in your liquid. You cannot reliably use the 18G needle to draw from a vial more than 10 times, but with the 22G needle you can. Finally, the 25G 1.5 IM needle is indeed the “gold standard” and has been for many decades – at least 50 years. Ask your local fertility doctor whose practice depends on high reliability of hormone injection.
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Can I ask what your body size is? I’m 6’1″ 220lbs. I’m hoping I can use all the sizes of supplies you mentioned that work great for you because that’s exactly what my provider gave me. I’m not comfortable buying different needles online or in person.
Injecting not infecting
Thank You, Beverly Cosgrove!!! Really useful information and sources for supplies! Gratefully, Lana LeSoleau, Las Vegas, NV USA
On Sat, Nov 7, 2020 at 03:14 MTF Trans Hormonal Therapy wrote:
> Beverly Cosgrove posted: ” By Beverly Cosgrove, Revision 14, November 6, > 2020 For AMAB trans people who take estrogens, the best combination of > safety and effectiveness is to use self injection of estrogen, particularly > in the form of estradiol valerate, and this is what I sugg” >
Thank you, Beverly, for all your hard work these many years. Just wanted to let everyone know that quickmedical.com no longer sells syringes or needles. They were my source for Nipro. Coincidentally, I tried to reorder from them 2 days ago! Perfect timing! I have used a Nipro 27ga.x1.25 needle and 1mL Luer Loc syringe for over 3 yr, and combine my estradiol and progesterone in each syringe.
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Thanks Beverly for doing an updated post on this subject. I’m not self medicating, but I’m interested in trying out the Nipro needles as you say they slide in easier. I’m sticking to the 25g 1.5 inch. I’m a bit afraid that 1.25 inches won’t go deep enough. I’ve done 6 injections so far and at this point I don’t even get any nerves sticking myself. I’m not needle phobic though, but jabbing yourself is a bit different than someone else poking you with a needle. Also 25g seems like I already don’t really feel it. I don’t find I need to do any twisting motion, but if that helps some people to stick themselves, that’s great, just don’t find it necessary myself.
The nurse that showed me how to inject actually suggests going into the upper butt muscle (gluteus medius), I’ve been doing it this way and I don’t feel any dips in hormone levels. I’m on only six weeks in though. Will be getting blood tests at trough next week for T and E levels (Thursday is my injection day, taking EC, so 7-8 day half life). I’m assuming my dosage will be upped as I’m only injecting 1.25mg (.25ml of 5mg/mL), my endo wanted to start low, check in six weeks and up as necessary.
For me, tight subcutaneous injection works just fine in the upper outer areas where I have the most fat layer.
It’s a valid option when one lack the fat from belly or otherwise the area is compromised.
I’ve also seen great reports (Lena) about deep subcutaneous injections in the butt where the release is even slower apparently but I haven’t tried that one yet myself.
Hey there, I thought this might be interesting. The implication being that 1.25″ 27g needles might actually get the oil deeper than 1.5″ 22g needles, though I’m not sure it would apply with oil and 1ml syringe. “Subsequent to this observation, we modified our techniques for IM and procedural injections and replaced the longer, larger needles with shorter, higher-gauge needles. When a higher 30-gauge needle is used with a 3 mL-syringe (Figure 2), there is increased velocity through the smaller needle and the distance the medication travels from the syringe and needle into the tissue is greater. The principle of conservation of mass is embodied in the equation of continuity which states that, in any steady state process, the rate at which mass enters a system is equal to the rate at which mass leaves the system (Figure 3).” https://www.practicalpainmanagement.com/treatments/interventional/injections/reinventing-im-procedural-injections-sota-omoigui-short-needle
First off thanks. Agree to a point. Luer locks are definitely better but hardly worth the extra cost in my opinion especially if you are careful.
Also minimal dead space syringes are also preferable however again not worth the cost, The average 1ml syringe looses less than 0.01 ml in the bezel.
I have monitored my Glute and Thigh injections with a series of labs and the thigh injections have not shown and discernible differences in blood levels over the same period. This is possibly due to muscle mass, metabolic rate and just plain individual differences. This is particularly evident where my girlfriend and I use the exact same process and dosage and I consistently have normal to high E2 levels and hers are consistently low.
Finally, really appreciate all the hard work you put into these articles, you are a keeper! Cheers, Breanna-Jade
Hi Beverly, since I saw your transition post on Quora several months ago, I’ve been on a quest to finally be able to communicate directly with you. Please, if you could , tell me if the generic injectables are available in Ontario Canada. We have severable compounding Pharmacies in our area, would this be my only option? My Dr has suggested that I use Estradiol Valerate, but it has a 5 day injection schedule rather than Estradiol Cypionate which has a 7 day schedule. I’m needle adverse but I’m concerned with the use of pills (4 mg) and Cyproterone acetate 12.5 mg. I’m computer illiterate, so I hope this actually gets to you. Thanks in advance for sharing your hard earned knowledge.
[…] here is step-by-step information. Be sure you have the right syringes and needles. I would take four 1ml syringes and put 22g 1.5 inch needles on them. Then, open two Estradiol […]
Nice read 🙂
I’m Keri, a Polish trans woman, self-injecting with Neofollin (Czech EV, 5mg in 1ml single-use vials) and I use a slightly different procedure.
2ml syringe (since I want to make sure I draw all of the vial’s content, and to do that, I’m bound to draw some air), 18G needle for drawing, 22G 30mm (1 1/4″) for injecting.
After changing the needle and removing all the air bubbles, puncture quickly, aspirate to make sure the needle didn’t end up in a blood vessel, then inject slowly and steadily. Then use a band-aid and massage the injection site to prevent the oil from escaping.
Hi, I use a 25G needle for the one-needle subq method. I find this needle very efficient for both drawing and injecting. Of course, I would feel less pain from a 30G needle than a 25G needle, but after a few injections you get used to it, and it is no problem anymore. I find it very practical not needing to mess with two needles.
I have been taking thermolysis for two years, and compared to the pain from this needle below my nose or on my neck, the subq injection is painless.
Sure, using a 25g needle works, but that’s because convenience is more important to you than pain level, as you said. Strictly speaking, a 30g needle will work too — if you don’t mind a long wait to draw the liquid. I’ve done this myself using a binding clip (like you use to clip notes together) to hold the plunger of the syringe still, so I can set aside the vial/syringe combination for 10 minutes to allow it time to fill. So, that would be an example where pain level is more important to me than speed. The two-needle method is the fastest and lowest pain method. But not the simplest or the cheapest. I described it in the article as the “optimum” because I thought most people would not mind spending 8 cents more, and taking one more step (changing the needle), if it meant the pain level was lowest.
Looking for information on vial coring I found this research.